EmblemHealth Dual Eligible (PPO SNP) By EmblemHealth Medicare PPO
EmblemHealth Dual Eligible (PPO SNP) is a 2014 Medicare Advantage Special Needs Plan plan by EmblemHealth Medicare PPO. This plan from EmblemHealth Medicare PPO works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from EmblemHealth Medicare PPO and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. EmblemHealth Dual Eligible (PPO SNP) H5528-018 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.
2014 Medicare Special Needs Plan Details
| Plan Name: | EmblemHealth Dual Eligible (PPO SNP) |
|---|---|
| Plan ID: | H5528-018 |
| Special Needs Type: | Dual-Eligible |
| Provider: | EmblemHealth Medicare PPO |
| Plan Year: | 2014 |
| Plan Type: | Local PPO |
| Monthly Premium C+D: | $34.00 |
Coverage Area for EmblemHealth Dual Eligible (PPO SNP)
The EmblemHealth Dual Eligible (PPO SNP) H5528-018 is available to residents in New York, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. EmblemHealth Dual Eligible (PPO SNP) is a Local PPO. A preferred provider organization (PPO) is a medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Total Ratings for EmblemHealth Dual Eligible (PPO SNP) H5528
| 2014 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Total Experience Rating | ||
| Complaints, Improvements | ||
| Total Customer Service Rating | ||
| Total Preventative Rating | ||
| Chronic And Long Term Care |
Member Experience Rating for EmblemHealth Dual Eligible (PPO SNP)
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Timely Care and Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints, Problems Getting Service and Improvements in Health Plans
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Access to Service | ||
| Performance Problems | ||
| Health Plan Quality Improvement |
Customer Service Rating for EmblemHealth Dual Eligible (PPO SNP)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Cardiovascular Screening | ||
| Diabetes Care | ||
| Glaucoma Testing | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Ratings For Managing Chronic And Long Term Care
| Total Rating | ||
|---|---|---|
| Medication Review | ||
| Functional Status Assessment | ||
| Pain Screening | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Diabetes Care - Cholesterol | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Part-C Premium
EmblemHealth Medicare PPO plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
The EmblemHealth Dual Eligible (PPO SNP) plan has a monthly drug premium of $34.00 and a $310.00 drug deductible. This EmblemHealth Medicare PPO plan offers a $34.00 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by EmblemHealth Medicare PPO above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $34.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The EmblemHealth Dual Eligible (PPO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $8.50 for 75% low income subsidy $17.00 for 50% and $25.50 for 25%.
| Part C Premium: | $0.00 |
|---|---|
| Part D (Drug) Premium: | $34.00 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $34.00 |
| Drug Deductible: | $310.00 |
| Tiers with No Deductible: | 0 |
| Benchmark: | below the regional benchmark |
| Type of Medicare Health Plan: | Actuarially Equivalent Standard |
| Drug Benefit Type: | Basic |
| Full LIS Premium: | $0.00 |
| 75% LIS Premium: | $8.50 |
| 50% LIS Premium: | $17.00 |
| 25% LIS Premium: | $25.50 |
| Inital Coverage Limit: | $2850 |
| Gap Coverage: | No Gap Coverage |
Gap Coverage
In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This EmblemHealth Medicare PPO plan covers No Gap Coverage through the gap. No Gap Coverage means 0% of formulary drugs are covered through the gap or 15 or less brand name products are covered through the gap.
Source: CMS.
Plans as of September 3, 2013.
Star Rating as of September 27, 2013.
For More Information on Ratings Please See the CMS Tech Notes Here.
Plans are subject to change as contracts are finalized.
Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.
